Sunday 21 October 2007

Thyroid examination

1. Examine the thyroid gland

2. Assess the thyroid status

3. Look at this pts neck

Examination of thyroid gland:

Look-feel-listen

1. Indroduce u r self, while shaking hands note whether the palms are warm & sweaty.

2. Inspection:

Inspect neck from anteriorly

-Look for the JVP

-Scars of the neck

-Enlarged Cervical LN

-Goitre

Ask the patient to take a sip of water,

Hold it, and then swallow it

Observe the movement of the gland

Ask the patient to stick the tounge out

Look for thyroglossal cyst

3. Palpation:

Do tell pt u r going to fell the neck& Ask for gland tenderness.

Stand behind the patient.

Feel the thyroid gland

Feel the isthmus

Feel for: diffuse goitre

Any area of focal nodularity

Size and texture

Note the following

-size

-symmetry

-skin turgor

-mobility

-texture

-tenderness

-palpate cervical LN

-Test sternomastoid to rule out its involvement in malignancy.


Ask the patient to take onother sip of water while feeling the thyroid movement.


4. Auscultate with the diaphragm bilaterally for briut, carotid bruits

5. Percuss for retrosternal extension


Conclusion: describe the gland and say I would like to examine the status.

Examine the thyroid status:

Composure:

Hyperactive, fidegty, restless

Normal


Pulse;

Tachycardia/AF

Bradycardia


Hand:

Sweating

Thyroid acrobachy

Tremers of out streched arm


Eyes:

Exophthamous

Chemosis

Opthalmopelgia

Diplopia

Cogectival injection

Led lag/retraction


Legs:

Peritebial myxedaema


Ask about:

Temp preferance

Wt change

Apetite

Bowel habits

Palpitations

Change of temper



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